Nearly 16 million adults in the United States have chronic obstructive pulmonary disease (COPD) but this is probably a woeful underestimate as many adults are asymptomatic in early stages. Screening is only recommended if patients exhibit symptoms and have risk factors. However, the most rapid decline in lung function occurs during GOLD stage 1. As COPD progresses, mortality, morbidity, and the economic burden increase very significantly. These facts suggest a need to detect and treat early-stage disease to slow its progression. The Tie-COPD study provides some new evidence that early treatment might be beneficial.